I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

Quilts of Valor

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Monday, March 9, 2009

The full title is “Indications for Breast MRI in the Patient with Newly Diagnosed Breast Cancer.” It is a Medscape CME article. The article discussed exactly what the title implies. It does so by looking at the published research.

Some of their findings:

MRIs have a high sensitivity for detecting otherwise occult cancers in women recently diagnosed with breast cancer.

MRIs can improve assessment of disease extent in the breast known to be affected with cancer and may detect mammographically occult cancer in the contralateral breast.

Nothing published suggests that breast MRI should be used as a substitute for screening or diagnostic mammography.

MRIs should be used as an adjunct to mammography and not in lieu of standard breast imaging with mammography and, when indicated, diagnostic breast ultrasound.

MRI detects the primary cancer in up to 70% of these patients with adenocarcinoma meta states in the axillary lumph nodes without an identified primary source, changing the staging from T0 (unknown primary) to the defined T1 to T3.

To address the current lack of standardization in MRI technique, the American College of Radiology (ACR) is developing a voluntary Breast MRI Accreditation Program, which will include minimum standards for breast MRI.

4 comments:

ilquiltingqueen
said...

I've been reading your blog for several months, mainly for the quilting. However, today's post caught my attention since I just got an unexpected diagnosis last Friday: ductal carcinoma. I will have my breast MRI tomorrow and will see the surgeon next Tuesday. We are lucky to have a local Susan G. Komen Breast Center with a caring staff. The Breast Health Navigator just called to check on me, to see if I had any questions or concerns.

My question is…how do you find a site with qualified people to read the MRI specifically trained for breast cancer?

I was diagnosed with DCIS Stage 0 in July, after a diagnostic mammogram showed calcifications. First lumpectomy did not get clear margins, as the area of DCIS found by pathology was larger than what shown on the mammogram. I had a reexcision to remove more, but no one can really tell me if there is not more DCIS lurking in the breast that also does not show up as calcifications. I thought this was a good reason to request an MRI. I also have a strong family history of breast cancer. No first degree relatives, but but 3 out of 5 aunts on each side, and most male members with prostate cancer. BRCA test was recommended and was negative. Yet I was told that because of the risk of false positives and the difficulty of reading a breast MRI, that they were not favored by this hospital (actually a network of 3 teaching hospitals, which are definitely considered the place of choice to have cancer treatment in this area).

I would be happy to foot the bill for an MRI myself…but how does one find out who can do it properly, and at what institutions are they to be found?

Linnea, how do you find a site with qualified people to read the MRI specifically trained for breast cancer?

You will have to ask about the radiologist at your breast center. Ask the center. Ask the radiologist. Major breast centers and university hospitals with teaching programs usually fit those requirement.

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